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Humongous Insurance

Psikogeriatri 1
Eri Achmad
PSIKIATER
eriachmad@yahoo.co.id

• RSUD Arjawinangun
• RS Mitra Plumbon
• RS Sumber Waras
Pemeriksaan Psikogeriatri
• Pemeriksaan psikogeriatri:
– Pemeriksaan status mental / neuropsikologik
• Definisi pemeriksaan neuropsikologik
• Prinsip penilaian neuropsikologik

– Evaluasi neuropsikologik
• Jenis intrumen yang digunakan
• Penggunaan GDS dan MMSE

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Batasan Lanjut Usia
• UU No 13 th 1998 lanjut usia adalah 60 th
keatas
• WHO dalam Menkes RI
– 45-59 middle/young elderly
– 60-74 elderly
– 75-90 old
– >90 very old
• Papalia, Olds & Feldman, 2005:
– 65 74 young old, 75-84 old-old, > 85 oldest old

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Pendahuluan
• Indonesia peringkat ke IV dunia
peningkatan populasi lansia
• 2020 sekitar 28,8 juta jiwa, peringkat ke-
10 dunia
• Lansia terlantar sekitar 2.426.191 jiwa
atau 15 persen dan sekitar 4,6 juta Lansia
atau 29 persen rawan terlantar
• UU No. 13 Tahun 1998 tentang
Kesejahteraan Lansia

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Lanjutan....
• PP No. 43 tahun 2004 tentang
Pelaksanaan Upaya Peningkatan
Kesejahteraan Sosial Lansia
• Kepres No. 52 tahun 2004 tentang Komisi
Nasional Lansia
• Permendagri No. 60 Tahun 2008 tentang
Pedoman Pembentukan Komisi Daerah
Lansia dan Pemberdayaan Masyarakat
dalam Penanganan Lansia di daerah

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Lanjutan....
• Pemerintah Targetkan 2020 Lanjut Usia
Sejahtera dengan JSLU

Sumber: Lembaga Lansia Indonesia (LLI)

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Pemeriksaan Neuropsikologik
pada Lanjut Usia

Fisik

Mental- Fungsional
Psikologik -Disabilitas
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Pemeriksaan Neuropsikologik
• Definition (Kaplan & Sadock’s, 10th ed)
– Clinical neuropsychology is a specialty in
psychology that examines the relationship
between behaviour dan brain functioning in the
realms of cognitive, motor, sensory, and emotional
fucntioning.
– Integrates the medical and psychosocial history
with the reported complaints and the pattern of
performance on neuropsychological procedures to
determine whether results are consistent with a
particular area of brain damage or a particular
diagnosis
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Pemeriksaan Neuropsikologik
pada Lanjut Usia
A. Pemeriksaan Status Mental
B. Evaluasi Neuropsikologik

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Prinsip
• Adalah penting
– Membedakan penuaan alami dengan proses penyakit
– Menemukan korelasi kondisi fisik dengan lingkungan
• Penuaan berhubungan dengan peningkatan
– Penyakit
– Kecelakaan
– Stres

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Mental Status Examination
• Cross-sectional view of how a patient
– Think
– Feels
– Behaves
• During the examination
• May not able to rely on a single examination
• Noted a fluctuating changes from patient’s
family reports

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Continued.....
• General Description
– Appearance
– Psychomotor activity
– Attitude toward examiner
– Speech activity
• Functional assessment
– ADL
– IADL

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Functional Assessment
• ADL • Instrumental ADL
– Feeding • Cooking
– Bathing
• Cleaning
– Toileting
• Using telephone
– Dressing
– Transfer from • Writing
toilet • Reading
– Visual actuity • Laundry
– Others
• Driving a car
• Others
Continued.....
• Mood, Feelings, and Affect (Emotions)
– Congruent
– Incongruent
• Perceptual disturbances
– Hallucination
– Illusions
– Agnosia
• Language output

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Continued.....
• Visuospatial functioning
• Thought
• Sensorium and cognition
– Consciouness
– Orientation memory
– Intelelctual task, information, and intelegence
• Reading and writing
• Judgement

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Evaluasi Neuropsikologik
• Assessment criteria for measurements
– Variables must be indicative of a function
important for the general health of the individual
– Must correlate with chronological age
– Must change sufficiently, and with regularity, over
time to show differences over 3-5 year intervals
– Must be easily measured without discomfort for
the individual (without great expense & excessive
labor)

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Continued.....
• Purpose
– Highest priority
• Prevention of decline in the independent performance of
ADLs
• Drives the diagnostic process and clinical decision making
– Screen for preventable diseases
– Screen for functional impairments that may result
in physical disability and amenable to intervention
– Detecs noncomplaining but impaired geriatrics

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Continued.....
• 3 step process
1. Targeting appropriate patients
2. Assessing patients and developing
recommendations
3. Implementing recommendations

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Who needs
Neuropsychological Evaluation
• For patients with living situation in transition
• Recent development of physical or cognitive
impairments
• Patients with fragmented specialty medical
care
• Evaluating patient competency/capacity
• Dealing with medico-legal issues

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All Older
Persons

Apply Targeting
Criteria

Too Sick to Appropriate Too Well to


Benefit and will Benefit Benefit

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1. Too Sick to Benefit
– Critically ill or medically unstable
– Terminally ill
– Disorders with no effective treatment
2. Appropriate and Will Benefit
– Multiple interacting biopsychological problems
that are amenable to treatment
– Disorders that require rehabilitation therapy
3. Too Well to Benefit
– One or a few medical conditions
– Needing prevention measures only
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Types of neuropsychological test

• Mini Mental State


Examination
– Cognitive function tes
• Orientation, attention,
calculation, immediate
dan short term recall,
language, and the
ability to follow simple
commands
• Executive function
Executive Function
• Multi-factorial set of cognitive abilities
required to plan and carry out complex, goal-
oriented behavior:
– learning new information, retrieval of long-term
memory
– prospective memory, goal planning
– task organization and strategy formation
– attention, cognitive flexibility, working memory
– temporal sequencing

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Continued.....
– abstracting, novel problem solving
– motor programming
– inhibiting over-learned responses
– alternating behavioral patterns in response to
environmental
– feedback, self-regulation/self-monitoring
– mood management

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• Geriatric
Depression Scale
Pemeriksaan Medik Fisik
• Status fisik
– Vital sign
• Riwayat medik fisik dahulu
 Riwayat penyakit, alergi
 Riwayat pengobatan
 Riwayat trauma
 Riwayat operasi
 Riwayat penyakit turunan

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• Pemeriksaan penunjang medik sesuai indikasi
• CT Scan
• X ray
• USG, dll
• Konsultasi antar bagian jika diperlukan

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Format laporan
• Keterangan umum
– Nama, umur, sex, alamat dll
• Pemeriksaan neuropsikologik
– Status mental
• Pikiran, emosi, perilaku, RPD, RPK, dll
– Evaluasi neurologik
• GDS, MMSE, ADL/IADL
• Pemeriksaan fisik
– Status fisik; RPD, RPK, alergi dll
– Penunjang; CT scan, USG, Lab rutin, dll

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Daftar masalah
No Pemeriksaan Intervensi
1. Neuropsikiatrik

2. Fisik

3. Fungsional

4. Global

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